Sandbox:Mitra3

{{familytree | G01 | | G02 | | G03 | | G04 |G01=

❑ Classic triad of:

❑ Hypotension

❑ Elevated JVP

❑ Clear Lungs

❑ Kussmaul sign
❑ Pulsus paradoxus
❑ Tricuspid regurgitation murmur
❑ Atrioventrcicular dissociation
❑ Vagal symptoms:

❑ Bradycardia

❑ Nausea

❑ Vomiting

❑ Diaphoresis

❑ Pallor

|G02=

❑ RV dilatation
❑ Depressed RV systolic function
❑ RV wall akinesia or dyskinesia
❑ RA enlargement
❑ Elevated pulmonary pressures
❑ Pulmonary regurgitation
❑ Tricuspid regurgitation
❑ Increased right atrial pressure

|G03=

Gold standard diagnostic modality

❑ In the majority of RVMI:

❑ The culprit artery: Proximal RCA

❑ Occasionally:

❑ The culprit artery: Left circumflex artery or left anterior descending artery

|G04=

❑ Hemodynamically significant RVMI:

❑ Increased RAP>10 mmHg

❑ RAP to PCWP ratio >0.8 (normal<0.6)

❑ RAP within 5 mmHg of the PCWP

❑ Reduced cardiac index

❑ Disproportionate elevation of right-sided filling pressures: Hallmark of RVMI

❑ In concomitant LV dysfunction:

❑ RAP to PCWP ratio can change

❑ Additional hemodynamic changes:

❑ Prominent [[Y-descend of the RAP

❑ Drop of the systemic arterial pressure >10 mmHg with inspiration

❑ "Dip and plateau" morphology and equalization of the diastolic filling pressures
|}}

All patients with acute inferior wall myocardial infarction (ST elevation in leads II, III, aVF)

Obtain right-sided precordial leads

>= 1mm ST elevation in lead V4R

Highly suggestive of RVMI

Physical examination

Echocardiography

Coronary Angiography

Hemodynamic study